Employment Inquiry

EMPLOYMENT INQUIRY FORM

Thank you for your interest in obtaining a position with Arctic Bear Plumbing, Heating & Air, Inc..
The following is a simple inquiry form to see if it is in your interest to
take the time to come in and fill out our normal employment application and
potentially interview for possible employment.

All information submitted will be held in strict confidence. No phone calls
will be made to your current or past employers without first talking to you.
Arctic Bear Plumbing, Heating & Air, Inc. is a drug-free workplace and will conduct a background check
on all employee prospects before hiring.

Contact Information

*First Name :

*Last Name :

Middle Initial:

*Address 1:

Address 2:

*City:

*State:

*Zip Code:

*Home Phone #:

Personal Cell Phone #:

*E-mail:

*Confirm E-mail:

Do you have a valid Driver's License?:
Yes No

*Type of Work Desired:

*Days / Hours Available:

Have you applied with us before:
If Yes, When:

Education & Certifications

High School

Number of years attended:

Did you graduate:
Yes No

Name and Location of School:

Subjects Studied:

College

Number of years attended:

Did you graduate:
Yes No

Name and Location of School:

Subjects Studied:

Trade or Business School

Number of years attended:

Did you graduate:
Yes
No

Name and Location of School:

Subjects Studied:

Current Certifications and Licenses:

Have you ever been convicted of a felony?

If yes, please provide details:

Employment History

Company Name:

Date From - Date To

-

Starting pay rate
$ Hourly
Monthly Annually

Ending pay rate
$ Hourly
Monthly Annually

Duties:

Reason for Leaving:

Name of Supervisor:

Supervisor's Title:

Supervisor's Phone # or reason to not contact:

Company Name:

Date From - Date To

-

Starting pay rate
$ Hourly
Monthly Annually

Ending pay rate
$ Hourly
Monthly Annually

Duties:

Reason for Leaving:

Name of Supervisor:

Supervisor's Title:

Supervisor's Phone # or reason to not contact:

Company Name:

Date From - Date To

-

Starting pay rate
$ Hourly
Monthly Annually

Ending pay rate
$ Hourly
Monthly Annually

Duties:

Reason for Leaving:

Name of Supervisor

Supervisor's Title:

Supervisor's Phone # or reason to not contact:

References

Reference 1 Name:

Reference 1 Phone Number:

Reference 2 Name:

Reference 2 Phone Number:

Reference 3 Name:

Reference 3 Phone Number:

Additional Skills

Other Skills:

Special Training :

Free Water Analysis

Fill out this form to receive a FREE water analysis by our Licensed Water Specialist.

NameEmailPlease let us know more about your water treatment or water softener problem.

NYSEG Rebate Program

NYSEG is offering a rebate rebate-program to its residential natural gas customers on new residential natural gas equipment and duct sealing. Follow the link for information on the rebate program.